Table of ContentsView AllTable of ContentsWhat Is a Fistula?Fistulas in Crohn’sFistula Repair OptionsOngoing ManagementFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is a Fistula?
Fistulas in Crohn’s
Fistula Repair Options
Ongoing Management
Frequently Asked Questions
A fistula develops when there is a connection between two organs in the body, or an organ and the skin, that doesn’t belong there. Fistulas can result from different diseases and conditions, but they tend to be commonly associated with Crohn’s disease.
With Crohn’s disease (an inflammatory bowel disease causing inflammation of the digestive system), a fistula often affects the colon and the area around the anus (the perianal area). Having a fistula can be painful, embarrassing, and scary, and it can lead to a lower quality of life. Although it may take time for a fistula to heal, there are treatments available.
There are nonsurgical ways to heal a fistula, but fistula repair may require surgery. Some types of fistula repair are the rectal flap procedure, endoscopic fistula repair, a fistula plug, ligation of intersphicteric fistula tract (LIFT), and seton placement. This article discusses both surgical and nonsurgical ways to heal a fistula.
Verywell / Laura Porter
A channel that forms abnormally between two organs or an organ and the skin is called a fistula. Fistulas can happen anywhere in the body, but they most commonly affect thedigestive system, or digestive tract.
Having a condition such asinflammatory bowel disease(IBD), which includesCrohn’s diseaseandulcerative colitis, increases the risk of developing a fistula. After the first year of diagnosis, people with Crohn’s disease have about a 21% chance of developing a fistula. About 12% of people with Crohn’s disease have a fistula at any given time.
Fistulas can be a special problem for women with Crohn’s disease when they affect the vagina.
Inflammation and Fistula Development
Crohn’s disease can cause inflammationin any part of the digestive tract. Further, all the layers of the walls of the intestines can be affected. It’s thought that this inflammatory process may lead to the formation of fistulas.
Types of Fistulas in Crohn’s
There are severaltypes of fistulasthat are more common in people with Crohn’s disease. They can be classified in a few different ways.
One of the ways a fistula is classified is according to the location in the body. This includes:
Another way fistulas can be classified is as either simple or complex. Most fistulas associated with Crohn’s disease are classified as complex. Complex fistulas may be more challenging to treat and heal.
A fistula may be classified as complex if it:
Symptoms and Location
A fistula may have different symptoms based on where it is located.
An anal fistula may have symptoms such as:
A fistula that involves the bladder and the intestines can have symptoms of:
Rectovaginal fistulas involve the rectum and the vagina and might cause:
Fistulas between the large and small intestine might cause:
Fistulas between the intestines and the skin could lead to fecal matter (stool) leaving the body through the opening. Some fistulas might not cause any specific symptoms or the symptoms might not be pronounced enough to be noticeable or seem like they’re from a fistula.
By one estimate, the ratio of fistulas in Crohn’s disease is:
Fistula Repair: Your Options
There are different options for treating a fistula, both surgical and nonsurgical. The treatments that are used will be based on the location of the fistula and how complicated it is, as well as other factors.
Nonsurgical
Some types of fistulas may respond to treatments such as medications or special nutrition, and surgery won’t be needed.
Antibiotics: When stool is involved, there can be a risk of an infection from the bacteria it contains. Antibiotics may not be all that’s needed to heal a fistula but may help in preventing future complications.
If there are abscesses, those may need to be treated with antibiotics before a biologic can be used. This is because some biologic medications (especially those classified as antitumor necrosis factor inhibitors) may increase the risk of infections.
Immunosuppressants: Because a fistula may be associated with the inflammation from Crohn’s disease, treating that problem with these medications may be important. These drugs may work better in the case of uncomplicated fistulas.
Nutritional therapy:Nutritional therapy is sometimes used to treat Crohn’s disease, more often in children than in adults. If a fistula involves the bowel, giving that area a rest from solid stool moving through it may help it to heal. In that case, enteral nutrition or intravenous nutrition might be used.
Enteral nutrition is liquid nutrition, in which all or most calories are from specially fortified drinks delivered directly into the gastrointestinal tract. Intravenous nutrition, or parenteral nutrition, is delivering a special formula intravenously (IV, through a vein), and few or no calories are taken in through food.
Surgery
Surgery is sometimes needed to treat a fistula. Surgery may be used along with medical therapy to heal a fistula. If there are abscesses, those are usually drained or treated with antibiotics prior to having surgery. Surgery includes:
Seeing a Specialist
Fistula repair is complicated and requires care from a specialist. Unfortunately, some fistulas are difficult to heal and there is a possibility that they may return.
Agastroenterologist(a doctor specializing in treating disorders of the stomach and intestines) may also be part of the team when medical treatment is necessary. There may be other healthcare professionals involved as well, including a surgical nurse or gastrointestinal nurse.
Ongoing Management and Aftercare
Surgical treatments aren’t without risks. Some of the potential complications after surgical treatment of a fistula include:
Going to the Bathroom
Ice packs might be used in the area to prevent swelling and to help with discomfort.Wiping after a bowel movementmay be uncomfortable so using a bidet (toilet attachment that sprays water), wet wipes, or a peri bottle (a squirt bottle designed to reach the perianal area) could help.
Feeling Secure
Being diagnosed with a fistula is challenging. It can be embarrassing to discuss, especially when the fistula involves the anal area or the vagina. However, it’s also important to tell your doctor everything about the fistula, including if it’s causing pain or if there is stool coming from the opening on the skin or the vagina.
It may help to work with a mental health professional to work through the emotions involved. If you are in a relationship, you may wish to seek couples therapy, especially when a fistula is impacting intimacy.
Having fears regarding a fistula and its treatment is expected. It’s challenging to tell a healthcare team about these concerns, but healthcare providers may be able to put many of your worries in perspective and help you cope. An ostomy or wound care nurse will be a good resource in learning how to manage a fistula.
Summary
People with Crohn’s disease may develop a fistula, an abnormal connection between two organs or an organ and the skin, in the digestive tract due to inflammation. A perianal fistula, a fistula between two parts of the intestines, and a fistula between the rectum and vagina are the three most common types.
There are surgical and nonsurgical options for treating fistulas. Which is right for you will depend on the location of the fistula and the complexity of treatment. After treatment, constipation must be avoided.
A Word From Verywell
Having a fistula is inconvenient, uncomfortable, and embarrassing. It is necessary to get it treated, however, in order to avoid more serious complications. In some cases, it may be necessary to advocate for yourself to get healthcare providers to look into the symptoms and to find the fistula.
There are some choices to make regarding treatment options. Understanding the potential effects may take time and asking a lot of questions. However, it will be worth the time and effort becausehealing the fistulais important in preventing a recurrence and improving your quality of life.
In some cases, it might not be easy to tell that there is a fistula. In general, however, having pain, unexplained fevers, lumps or bumps in the anal area, or stool leaking from the vagina are some of the signs and symptoms.If something doesn’t seem right, it’s important to bring it up with a doctor and keep bringing it up to get the tests that are needed to diagnose a fistula.
In some cases, it might not be easy to tell that there is a fistula. In general, however, having pain, unexplained fevers, lumps or bumps in the anal area, or stool leaking from the vagina are some of the signs and symptoms.
If something doesn’t seem right, it’s important to bring it up with a doctor and keep bringing it up to get the tests that are needed to diagnose a fistula.
Recovery from surgery for a fistula varies and depends on the type of repair that’s done and the complexity of the fistula. Most people will need to take some time off work or school, at least a week or more.The surgeon will have more instructions around recovery, but it’s possible it could take several weeks of self-care.
Recovery from surgery for a fistula varies and depends on the type of repair that’s done and the complexity of the fistula. Most people will need to take some time off work or school, at least a week or more.
The surgeon will have more instructions around recovery, but it’s possible it could take several weeks of self-care.
Fistula surgery is complex and requires a week or more of aftercare. It may be done as an outpatient procedure, but it will be important to follow any instructions afterward for a smooth recovery.The surgeon and a gastroenterologist or other healthcare professionals will help in weighing the pros and cons of each type of procedure and choosing the right one with the best chance of recovery.
Fistula surgery is complex and requires a week or more of aftercare. It may be done as an outpatient procedure, but it will be important to follow any instructions afterward for a smooth recovery.
The surgeon and a gastroenterologist or other healthcare professionals will help in weighing the pros and cons of each type of procedure and choosing the right one with the best chance of recovery.
In some cases, there might not be any pain or discomfort with a fistula. In others, there could be an abscess that causes pain, burning, or fever.A fistula that involves the vagina may mean lots of drainage. A fistula that involves the bladder could be painful if there is stool leaking into the bladder and causing urinary tract infections
In some cases, there might not be any pain or discomfort with a fistula. In others, there could be an abscess that causes pain, burning, or fever.
A fistula that involves the vagina may mean lots of drainage. A fistula that involves the bladder could be painful if there is stool leaking into the bladder and causing urinary tract infections
You should talk to your healthcare team and an insurance carrier representative to learn what will be covered. The surgical team may need to submit documents to show that the surgery is necessary and that it should be covered.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P.Comparison of the efficacy of the various treatment modalities in the management of perianal Crohn’s fistula: A review.Cureus. 2020;12(12):e11882. doi:10.7759/cureus.11882.Schwartz DA, Tagarro I, Carmen Díez M, Sandborn WJ.Prevalence of fistulizing Crohn’s disease in the united states: Estimate from a systematic literature review attempt and population-based database analysis.Inflamm Bowel Dis. 2019;25:1773-1779. doi:10.1093/ibd/izz056.Lightner AL, Ashburn JH, Brar MS, et al.Fistulizing Crohn’s disease.Curr Probl Surg. 2020;57(11):100808. doi:10.1016/j.cpsurg.2020.100808.Lamb CA, Kennedy NA, Raine T, et al.British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.Gut. 2019;68(Suppl 3):s1-s106. doi:10.1136/gutjnl-2019-318484.Khisa W, Wakasiaka S, McGowan L, Campbell M, Lavender T.Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya.BJOG. 2017;124(3):503-510. doi:10.1111/1471-0528.13902.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P.Comparison of the efficacy of the various treatment modalities in the management of perianal Crohn’s fistula: A review.Cureus. 2020;12(12):e11882. doi:10.7759/cureus.11882.Schwartz DA, Tagarro I, Carmen Díez M, Sandborn WJ.Prevalence of fistulizing Crohn’s disease in the united states: Estimate from a systematic literature review attempt and population-based database analysis.Inflamm Bowel Dis. 2019;25:1773-1779. doi:10.1093/ibd/izz056.Lightner AL, Ashburn JH, Brar MS, et al.Fistulizing Crohn’s disease.Curr Probl Surg. 2020;57(11):100808. doi:10.1016/j.cpsurg.2020.100808.Lamb CA, Kennedy NA, Raine T, et al.British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.Gut. 2019;68(Suppl 3):s1-s106. doi:10.1136/gutjnl-2019-318484.Khisa W, Wakasiaka S, McGowan L, Campbell M, Lavender T.Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya.BJOG. 2017;124(3):503-510. doi:10.1111/1471-0528.13902.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P.Comparison of the efficacy of the various treatment modalities in the management of perianal Crohn’s fistula: A review.Cureus. 2020;12(12):e11882. doi:10.7759/cureus.11882.Schwartz DA, Tagarro I, Carmen Díez M, Sandborn WJ.Prevalence of fistulizing Crohn’s disease in the united states: Estimate from a systematic literature review attempt and population-based database analysis.Inflamm Bowel Dis. 2019;25:1773-1779. doi:10.1093/ibd/izz056.Lightner AL, Ashburn JH, Brar MS, et al.Fistulizing Crohn’s disease.Curr Probl Surg. 2020;57(11):100808. doi:10.1016/j.cpsurg.2020.100808.Lamb CA, Kennedy NA, Raine T, et al.British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.Gut. 2019;68(Suppl 3):s1-s106. doi:10.1136/gutjnl-2019-318484.Khisa W, Wakasiaka S, McGowan L, Campbell M, Lavender T.Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya.BJOG. 2017;124(3):503-510. doi:10.1111/1471-0528.13902.
Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P.Comparison of the efficacy of the various treatment modalities in the management of perianal Crohn’s fistula: A review.Cureus. 2020;12(12):e11882. doi:10.7759/cureus.11882.
Schwartz DA, Tagarro I, Carmen Díez M, Sandborn WJ.Prevalence of fistulizing Crohn’s disease in the united states: Estimate from a systematic literature review attempt and population-based database analysis.Inflamm Bowel Dis. 2019;25:1773-1779. doi:10.1093/ibd/izz056.
Lightner AL, Ashburn JH, Brar MS, et al.Fistulizing Crohn’s disease.Curr Probl Surg. 2020;57(11):100808. doi:10.1016/j.cpsurg.2020.100808.
Lamb CA, Kennedy NA, Raine T, et al.British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.Gut. 2019;68(Suppl 3):s1-s106. doi:10.1136/gutjnl-2019-318484.
Khisa W, Wakasiaka S, McGowan L, Campbell M, Lavender T.Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya.BJOG. 2017;124(3):503-510. doi:10.1111/1471-0528.13902.
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